| NPI | 1407087083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 100358) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS038026) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 051829) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 31582) | |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2016-09-19 |